“Because menopause happens to people.”
This is the phrase that welcomes visitors Queer Menopause, a website designed to raise awareness of LGBTQ+ experiences in menopause, provide resources and support better education for healthcare providers (HCPs). The statement itself serves as an obvious indication of inclusion.
Menopause symptoms can manifest differently for everyone, and the spectrum of LGBTQ+ identities (including gender diversity) adds additional nuance to an already individualized experience. For people who are not cisgender (when your gender identity matches the gender you were assigned at birth) or straight, existing menopause advice and discussions can feel irrelevant or dismissive of their journeys.
Whether it is due to family and community stigma or a lack of training for HCPs, accurate information about the menopausal transition can be difficult to find. And, when information is available, it does not necessarily include all experiences.
“That’s why I find it so disappointing when high-profile menopause organizations and activists stubbornly refuse to acknowledge the menopause experiences of non-binary and trans people. They make their resources clearly only available to women and that hurts everyone,” said the founder of Queer Menopause. Tanya GlideLondon-based psychotherapist and counselor specializing in working with LGBTQ+ clients.
In a study published in The Lancet, Glyde wrote that “queer Menopausal clients often experience multiple [forms of] discrimination in accessing treatment and health care services’. In our interview, Glyde expanded on this, saying that people need to be aware that what they are experiencing may be perimenopause or early menopause, and the lack of inclusive resources means that this information may not be accessible to them at all. .
“You don’t know what you don’t know, particularly if the resources aren’t developed with you in mind,” Glyde said. “People should then feel comfortable enough to approach their GP or other doctor. Many LGBTQIA+ people can’t be sure that they don’t have assumptions about their sex lives and relationships, e.g. that they are married to a man and have PIV [penis-in-vagina] sex, for example.”
Read: Do transgender women experience menopause? >>
Why is it important to include the LGBTQ+ community in the menopause conversation?
LGBTQ+ people have worse results for multiple health conditions and are less likely to receive help from professionals because of how they may be treated. This history could make it even more difficult to seek medical help for menopause, which is already stigmatized.
Menopause can lead to the development of new ones physical and mental health issues, and worsen pre-existing conditions. LGBTQ+ people are at higher risk for mental health conditions.
Language that refers to all patients as “ladies,” “girls,” or “women,” for example, can be exclusionary to people who do not identify with these terms, such as nonbinary or trans people. The LGBTQ+ spectrum includes people who identify as women and people who don’t, so providers who want to be welcoming to all patients should consider more terms like “menopausal.” Asking for a patient’s pronouns and using them correctly can also help more people feel comfortable seeking care.
Lack of knowledge = lack of adequate care
Advocates note that a straight focus on cisgender can prevent people from getting the treatment they need because effective treatments can vary depending on one’s identity. For example, all menopausal people will have a drop in estrogen levels, but recommendations such as hormone therapy may need to be approached differently for people (as some transgender and intersex people with ovarian systems) on a sex-confirming hormonal regimen.
As another example, many menopausal people have genitourinary symptoms, such as vaginal dryness and atrophy, which can contribute to urinary tract infections and other health concerns. Too often, however, these concerns are addressed only in the context of sexual challenges with straight, cisgender partners. Any individual who could benefit from topical estrogen therapy for genitourinary symptoms, for example, may not have the opportunity to have these conversations if HCPs limit their focus to pain or discomfort during penetrative sex.
LGBTQ+ patients who is Help-seeking for sexual issues during menopause, such as low libido, may also be underserved if HCPs are not educated about sexuality outside of a straight, cisgender context.
“Not everyone in menopause is trying to please a partner, romantically or sexually,” Glyde said. “But someone may still have problems in their sexual and romantic relationships because of physical and emotional changes, and that needs to be documented and explored — and it needs to be heard.”
Read: Good sex with Emily Jamea: Sexual Fluidity >>
Inclusion for all
The need to include everyone in the menopause conversation doesn’t just stop with members of the LGBTQ+ community. People from all marginalized communities should be part of the conversation, including people of different racial or ethnic backgrounds, socioeconomic status, or other shared identities.
Glyde noted that you don’t have to be LGBTQ+ to benefit from advice on the Queer Menopause website, saying: “There are many groups whose menopause-related needs would benefit from greater visibility.”
Glyde also offered advice for HCPs who want to better treat all perimenopausal or menopausal patients.
“Listen to the young,” Glyde said. “It’s tomorrow’s menopause. Hear about their experiences of gender and sexuality, health and mental health. Learn about all the letters in the LGBTQIA+ acronym and take care of public-facing menopause resources and make them inclusive, either through neutral language or adding identities so no one is excluded.”
This educational resource was created with the support of Astellas.
